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Source publication
Doruk Ozgediz and Robert Riviello discuss the burden of premature death and disability and the economic burden of surgical conditions in Africa.
Context in source publication
Context 1
... a few steps across from the poorly equipped casualty ward at the national hospital in Uganda, where injured patients arrive without prehospital care, is the generously funded Infectious Disease Institute. While the postgraduate surgical training program struggles to recruit surgeons, surveys confirm that medical students are drawn instead to the research and income opportunities in infectious disease (Figure 1) [29]. Many of these students take nonclinical research positions, depleting the workforce available for patient care. ...
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Citations
... In addition to fatalities, RTCs were responsible for 2.9% of all DALYs in 2019 (the seventh most important contributor) and were the main cause of DALYs for those aged 10-49 years [2]. But, despite their prevalence and consequences, RTCs have been neglected within global health discourse [3][4][5]. In an attempt to stop and reverse the increasing trend in RTC burden, the United Nations described 2011-2020 as the global Decade of Action for Road Safety. ...
Incidence of road traffic collisions (RTCs), types of users involved, and healthcare requirement afterwards are essential information for efficient policy making. We analysed individual-level data from nationally representative surveys conducted in low- or middle-income countries (LMICs) between 2008–2019. We describe the weighted incidence of non-fatal RTC in the past 12 months, type of road user involved, and incidence of traffic injuries requiring medical attention. Multivariable logistic regressions were done to evaluate associated sociodemographic and economic characteristics, and alcohol use. Data were included from 90,790 individuals from 15 countries or territories. The non-fatal RTC incidence in participants aged 24–65 years was 5.2% (95% CI: 4.6–5.9), with significant differences dependent on country income status. Drivers, passengers, pedestrians and cyclists composed 37.2%, 40.3%, 11.3% and 11.2% of RTCs, respectively. The distribution of road user type varied with country income status, with divers increasing and cyclists decreasing with increasing country income status. Type of road users involved in RTCs also varied by the age and sex of the person involved, with a greater proportion of males than females involved as drivers, and a reverse pattern for pedestrians. In multivariable analysis, RTC incidence was associated with younger age, male sex, being single, and having achieved higher levels of education; there was no association with alcohol use. In a sensitivity analysis including respondents aged 18–64 years, results were similar, however, there was an association of RTC incidence with alcohol use. The incidence of injuries requiring medical attention was 1.8% (1.6–2.1). In multivariable analyses, requiring medical attention was associated with younger age, male sex, and higher wealth quintile. We found remarkable heterogeneity in RTC incidence, the type of road users involved, and the requirement for medical attention after injuries depending on country income status and socio-demographic characteristics. Targeted data-informed approaches are needed to prevent and manage RTCs.
... Surgical procedures are predicted to account for 11% of total global disease burden and 25 million disability-adjusted life years (DALYs) in Africa, the region with the highest concentration of surgical DALYs (38/1,000 population) (1). Surgery and trauma patients typically experience a sudden and significant systemic insult that commonly results in the decompensation of subclinical illnesses and creates potentially fatal effects (2). ...
Background
Thoraco-abdominal surgery cuts through muscle, disrupting the normal structure and function of the respiratory muscles, resulting in lower lung volumes and a higher risk of developing post-operative pulmonary complications (PPC). PPC remains an important cause of post-operative morbidity and mortality and impacts the long-term outcomes of patients after hospital discharge. This study was aimed at determining the incidence and factors associated with postoperative pulmonary complications among patients who underwent thoracic and upper abdominal surgery in the Amhara region of Ethiopia.
Methods
A multi-center follow-up study was conducted from April 1, 2022, to June 30, 2022, at comprehensive specialized hospitals in Amhara regional state, northwest Ethiopia. 424 patients were consecutively included in this study, with a response rate of 100%. A chart review and patient interview were used to collect data. A logistic regression analysis was performed to assess the strength of the association of independent variables with postoperative pulmonary complications.The crude odds ratio (COR) and adjusted odds ratio (AOR) with the corresponding 95% confidence interval were computed. Variables with a p-value of <0.05 were considered statistically significant predictors of the outcome variable.
Results
The incidence of postoperative pulmonary complication was 24.5%. Emergency procedures, preoperative SpO2 < 94%, duration of surgery >2 h, patients with a nasogastric tube, intraoperative blood loss >500 ml and post-operative albumin <3.5 g/dl were factors associated with pulmonary complications. The most common complications were pneumonia (9.9%) followed by respiratory infection (4.2%).
Conclusion
The incidence of postoperative pulmonary complication after thoracic and upper abdominal surgery remains high. Preoperative SpO2, duration of surgery, patients having a nasogastric tube, intraoperative blood loss and post-operative albumin were factors associated with post-operative pulmonary complications.
... Furthermore, most of the healthcare providers reside in the urban areas making it difficult for patients in rural areas to have access to surgical care [1]. The large volume of unmet surgical need in resource-limited countries has been the subject of enduring international attention [2][3][4][5]. Some indicate this volume is increasing as part of the 'epidemiological transition', in which the surgical burden of noncommunicable diseases and injuries associated with increased life expectancy and demographic changes outpaces the concomitant increases in medical staff, facilities, education and mobility associated with socioeconomic development [5][6][7]. ...
In response to the 2010 earthquake and subsequent cholera epidemic, St Luke’s Medical Center was established in Port-au-Prince, Haiti. Here, we describe its inception and evolution to include an intensive care unit and two operating rooms, as well as the staffing, training and experiential learning activities, which helped St Luke’s become a sustainable surgical resource. We describe a three-phase model for establishing a sustainable surgical centre in Haiti (build facility and acquire equipment; train staff and perform surgeries; provide continued education and expansion including regular specialist trips) and we report a progressive increase in the number and complexity of cases performed by all-Haitian staff from 2012 to 2022. The results are generalised in the context of the ‘delay framework’ to global health along with a discussion of the application of this three-phase model to resource-limited environments. We conclude with a brief description of the formation of a remote surgical centre in Port-Salut, an unforeseen benefit of local competence and independence. Establishing sustainable and collaborative surgery centres operated by local staff accelerates the ability of resource-limited countries to meet high surgical burdens.
... It also defined 6 national indicators to assess surgical care access, quality, and economic impacts on health systems (Table 1), accompanied by recommended goals for these indicators by 2030. [1][2][3][4][5] Several studies have focused their analysis on the need for and quality of surgical care, focusing on surgical volume; surgical, anesthesiology, and obstetric workforce; and perioperative morbidity/mortality. Nevertheless, the concept of access to surgical care remains poorly defined. ...
Introduction:
The Lancet Commission on Global Surgery seeks to improve surgical care outcomes and equity for the world population through 6 indicators outlined in its 2030 Global Surgery Report. Our study aimed to estimate the percentage of the Mexican population with access to surgical care within the 2-hour distance range (indicator 1), the surgical workforce density (indicator 2), and the number of surgical procedures performed per 100,000 inhabitants (indicator 3) during the year 2020. Knowing these indicators can help to design and implement policies to increase surgical care access coverage and equity in our country.
Methods:
Data related to population distribution, local referral hospitals, and surgical volume were obtained from the 2020 Mexican National Census. Information relating to hospital characteristics and surgical specialists was collected from the Secretariat of Health's public records. We calculated travel time between health care facilities and municipalities using the TrueWay Matrix API and R Studio.
Results:
Taking into consideration the health care system affiliation, the proportion of the Mexican population with timely access to essential surgery was 81.7%, with 29.3 specialists per 100,000 inhabitants and 726.9 annual procedures performed per 100,000 inhabitants. We identified clusters of municipalities where a low proportion of the population has timely access to essential surgery.
Conclusion:
These findings illustrate that changes in Mexican policy are required to facilitate more equitable and timely access to essential surgical care among the population.
... 16 Social inequalities and decreased access to health care facilities in LMICs cause minor surgical pathologies to transform over time into fatal diseases or lifelong disabilities. 17,18 A study conducted by Wu et al. 9 in the Dadaab Refugee Camp, in Kenya, reported that only 13.5% of all children with congenital anomalies and secondary disabilities who needed surgical treatment had received adequate management. 9 Another study performed by Ozgediz and Riviello 19 showed that most patients with conditions requiring surgical intervention in Africa never reached a health service. ...
... 19 Although surgical care can be more challenging to deliver than medical treatments, social initiatives may improve access to surgical procedures through donation programs and nonprofit ventures, reducing the gap in the access to surgery. 18 As shown in the present study, we have supported the development of an affordable program in an LMIC through donations and nonprofit ventures. If the physical infrastructure is available and trained human resources are set up at no cost, the gap in the access to surgical procedures among the underprivileged population might decrease. ...
Objectives Congenital malformations constitute the first cause of morbidity and mortality in childhood in Latin America. That is why, since 2001, a surveillance system for congenital malformations has been implemented in Bogota - Colombia. However, despite the increase in detection, an impact on treatment has not been achieved. The present study describes our experience with a novel social program focused on congenital urologic disorders.
Methods The present manuscript is a retrospective observational study. We reviewed two national databases containing patients with congenital malformations. Patients were actively contacted to verify the status of the malformations. Children in whom the malformation was confirmed were offered a free consultation with a multidisciplinary group. After screening for surgical indications, patients were scheduled for surgery.
Results Between November 2018 and December 2019, 60 patients were identified. In total 44, attended the consultation; the remaining did not attend due to financial or travel limitations. The most common condition assessed was hypospadias. In total, 29 patients underwent surgery. The total cost of care was of US$ 5,800.
Conclusions Active search improves attention times and reduces the burden of disease. The limitations to be resolved include optimizing the transportation of patients and their families, which is a frequent limitation to access health care.
... In fact, morbidity and mortality from common conditions needing surgical care have grown in these regions, while the development of essential surgical care has stagnated or regressed [8]. The thematic overlaps between surgery and NTDs as neglected conditions have previously been discussed [9], but this needs updating owing to newer research. Two NTDs requiring surgical interventions, LF and trachoma, account for 2.3 million years lost to disability (YLDs) [4]. ...
The surgical burden of neglected tropical diseases (NTDs) is set to rise alongside average temperatures and drought. NTDs with surgical indications, including trachoma and lymphatic filariasis, predominantly affect people in low- and middle-income countries where the gravest effects of climate change are likely to be felt. Vectors sensitive to temperature and rainfall will likely expand their reach to previously nonendemic regions, while drought may exacerbate NTD burden in already resource-strained settings. Current NTD mitigation strategies, including mass drug administrations, were interrupted by COVID-19, demonstrating the vulnerability of NTD progress to global events. Without NTD programming that meshes with surgical systems strengthening, climate change may outpace current strategies to reduce the burden of these diseases.
... Lack of surgeon and operating room availability was the largest contributing factor in delay of care. The existing surgical workforce crisis 19 is known to have significant 20 Rwanda is similar to many other LMICs in its need for expansion of the CMF surgical workforce. A lack of reconstruction materials (eg, plates and screws, implants) was another source of delay. ...
Objectives
Craniomaxillofacial (CMF) trauma represents a significant proportion of global surgical disease burden, disproportionally affecting low- and middle-income countries where care is often delayed. We investigated risk factors for delays to care for patients with CMF trauma presenting to the highest-volume trauma hospital in Rwanda and the impact on complication rates.
Study Design
This prospective cohort study comprised all patients with CMF trauma presenting to the University Teaching Hospital of Kigali, Rwanda, between June 1 and October 1, 2020.
Setting
Urban referral center in resource-limited setting.
Methods
Epidemiologic data were collected, and logistic regression analysis was undertaken to explore risk factors for delays in care and complications.
Results
Fifty-four patients (94.4% men) met criteria for inclusion. The mean age was 30 years. A majority of patients presented from a rural setting (n = 34, 63%); the most common cause of trauma was motor vehicle accident (n = 18, 33%); and the most common injury was mandibular fracture (n = 28, 35%). An overall 78% of patients had delayed treatment of the fracture after arrival to the hospital, and 81% of these patients experienced a complication (n = 34, P = .03). Delay in treatment was associated with 4-times greater likelihood of complication (odds ratio, 4.25 [95% CI, 1.08-16.70]; P = .038).
Conclusion
Delay in treatment of CMF traumatic injuries correlates with higher rates of complications. Delays most commonly resulted from a lack of surgeon and/or operating room availability or were related to transfers from rural districts. Expansion of the CMF trauma surgical workforce, increased operative capacity, and coordinated transfer care efforts may improve trauma care.
... In Sub-Saharan Africa, surgical conditions remain neglected in its healthcare systems [1,2]. Compared to rich nations in the Western world there is limited access to surgical services and therefore a low surgical output [3,4]. ...
... These logistical challenges are not new and may impede access to routine hospital surgical care and even the management of surgical camps [1,2,17]. It is important to take note of these challenges in order to persuade those in power to prioritize the available resources for surgical management. ...
... However, regular documentation of the camps' outcomes and a population-based estimate of the burden of surgical diseases has not been done. Ohene-Yeboah M et al. [4] and Debas HT et al. [18] estimated that in Africa, surgery can address 7% of disability-adjusted life years and there is a probable increase in this surgical burden [2,18]. This surgical camp in West Nile, Uganda was an eyeopener for many doctors in the region to improve their practise. ...
Introduction: In Sub-Saharan Africa, surgical conditions remain neglected in its health care systems. This results in a low surgical output from district hospitals with many patients referred to Referral Hospitals in the region. Therefore surgical camps in district hospitals are often necessary where volunteer surgical teams perform a wide range of mostly elective surgical procedures. These surgical camps are pre-planned activities carried out at no cost to the patients who belong to poor and hard to reach vulnerable communities. The objective of this surgical camp was to offer free specialised surgical service in a rural hospital and hence improve surgical access to a poor vulnerable community in Northern Uganda. Training basic surgical skills and the provision of continuous medical education to medical officers in the region was also part of the purpose of this surgical camp. Methods: A descriptive study using data collected from a one week surgical camp in the year 2011 was performed at St. Joseph's Maracha Hospital. Data from operating log forms regarding date of procedure, patient gender, clinical diagnosis, operation performed and type of anaesthesia was obtained. Data was analysed for age, sex, type and rate of surgical procedure and type of anaesthesia. The participants' involved specialist general surgeons, medical officers, clinical officers, theatre nurses and anaesthetists. Results: In total, 105 surgical procedures were performed during the 7-day-long camp. Mean age of the patients was 39.54 years. The male: female ratio was 1:0.38. Adult inguinal herniorrhaphy formed 68.6% of all surgical procedures. Conclusions: The bulk of surgical disease encountered during the camp were inguinal hernias. Surgical camps improve access to surgical care to vulnerable hard to reach populations and should become an integral part of health service delivery in rural Africa. Better knowledge and basic surgical skills resulting in better management of surgical cases by local medical officers is achieved with surgical camps.
... In general there is a tendency for surgical conditions to be neglected in healthcare systems in Sub-Saharan Africa [14,16]. There is a low surgical output due to limited access to surgical services compared to richer nations [17,11]. ...
This review highlights the history of the commencement of surgical training in East Africa. The challenges faced in setting up a recognised training curriculum in General Surgery are outlined. The supply of health professionals with surgical skills is disproportionate to the world burden of surgical disease. The disproportion between the burden of surgical disease and the low numbers of trained personnel is more pronounced in developing low income countries. General surgery is being left in referral hospitals with few staff as surgical subspecialisation is gaining momentum. The provision of essential general surgery management is therefore below par which is the responsibility of the General Surgeon. The surgical procedure as an emergency may not necessarily be done by the surgeon. In order to bridge the discrepancy, training of more general surgeons is required. Specialist surgeons should also be trained first as general surgeons as it will give them the ability to respond to a general surgical emergency when practising as specialists and will provide them with a good overall understanding of the needs in general surgery.
... In Sub-Saharan Africa, surgical conditions remain neglected in its healthcare systems [1,2]. Compared to rich nations in the Western world there is limited access to surgical services and therefore a low surgical output [3,4]. ...
... These logistical challenges are not new and may impede access to routine hospital surgical care and even the management of surgical camps [1,2,14]. It is important to take note of these challenges in order to persuade those in power to prioritize the available resources for surgical management. ...
... However, regular documentation of the camps' outcomes and a population-based estimate of the burden of surgical diseases has not been done. Ohene-Yeboah M et al. [4] and Debas HT et al. [15] estimated that in Africa, surgery can address 7% of disability-adjusted life years and there is a probable increase in this surgical burden [2,15]. This surgical camp in West Nile, Uganda was an eye-opener for many doctors in the region to improve their practise. ...
Introduction: In Sub-Saharan Africa, surgical conditions remain neglected in its health care systems. This results in a low surgical output from district hospitals with many patients referred to Referral Hospitals in the region. Therefore surgical camps in district hospitals are often necessary where volunteer surgical teams perform a wide range of mostly elective surgical procedures. These surgical camps are pre-planned activities carried out at no cost to the patients who belong to poor and hard to reach vulnerable communities. The purpose of this surgical camp was to offer free specialised surgical service in a rural hospital and hence improve surgical access to a poor vulnerable community in Northern Uganda. Training basic surgical skills and the provision of continuous medical education to medical officers in the region was also part of the objective of this surgical camp. Methods: A descriptive study using data collected from a one week surgical camp in the year 2011 was performed at St. Joseph's Maracha Hospital. Data from operating log forms regarding date of procedure, patient gender, clinical diagnosis, operation performed and type of anaesthesia was obtained. Data was analysed for age, sex, type and rate of surgical procedure and type of anaesthesia. The participants' involved specialist general surgeons, medical officers, clinical officers, theatre nurses and anaesthetists. Results: In total, 105 surgical procedures were performed during the 7-day-long camp. Mean age Original Research Article Wismayer; JAMMR, 33(22): 174-179, 2021; Article no.JAMMR.77305 175 of the patients was 39.54 years. The male: female ratio was 1:0.38. Adult inguinal herniorrhaphy formed 68.6% of all surgical procedures. Conclusions: The bulk of surgical disease encountered during the camp were inguinal hernias. Surgical camps improve access to surgical care to vulnerable hard to reach populations and should become an integral part of health service delivery in rural Africa.
